The dust is settling from the dash to the March 31st finish line to sign people up for insurance coverage through Connecticut’s health insurance exchange, Access Health CT. So how did we do? Are people going to get decent coverage? Is it affordable? Will the rate of uninsured in our state drop significantly? Will people be any healthier?
When you hear that Connecticut’s exchange is the “best in the country” they are referring to operations. Our website works better than most; so well in fact, that they are considering selling our system and expertise to other states. The call center also works well, with short wait times. This is probably because of their policy to embrace consumer complaints as a “blessing,” offering clues to improve the system.
The navigators and assisters did a phenomenal job of getting 118,000 people enrolled into Medicaid, almost the total number experts predicted to become eligible. Because Medicaid is income limited, it is likely that the vast majority of new enrollees were previously uninsured. This is a big accomplishment engaging hard-to-reach populations and overcoming the stigma of Medicaid coverage. The job was made easier by the program’s significant progress in recent years improving the quality of care and attracting more providers to participate.
What’s not working:
Enrollment into insurance plans may be reaching internal exchange goals, but too many, maybe most, of Connecticut’s uninsured are not buying, even with subsidies.
It’s not clear yet how many of the exchange’s customers were previously uninsured but it is likely to be less than half. Saving money for some people who were already purchasing insurance is a good thing, but the point of the Affordable Care Act was to cover the uninsured.
When asked why people aren’t buying insurance, the overwhelming answer is the price. Connecticut’s premiums are fourth highest in the U.S. — the highest among state-based exchanges.
The good news is that we know how to fix this. All our surrounding states negotiate premiums with insurers in their exchanges and all have lower prices. So far, Connecticut policymakers have rejected this common sense policy and other options to make coverage affordable.
Connecticut’s exchange is still resisting independent consumer advocacy input and membership on the board. But insurers are well represented and too many board members have conflicting interests. Independent consumers and advocates have crucial expertise to make the exchange successful — expertise the exchange can’t buy at any price.
What is unclear:
There are early signs that people signing up for insurance through the exchange are older than most uninsured state residents. To be affordable, the exchange needs to attract young, healthy people spreading the costs of care across a broad pool. If enrollment is skewed toward older people with high costs, premiums will rise even higher, as happened to the Charter Oak program.
It’s not clear if there will be enough providers participating in exchange plans to meet the need. If people pay their premiums every month but can’t see a doctor when they need one, enrollment will drop. Buying a plastic card doesn’t make people healthier.
While the jury is still out on Connecticut’s insurance exchange, there is a lot more to the Affordable Care Act. Children can stay on their parents’ policies until age 26, people can’t be denied coverage for pre-existing conditions, and dozens of innovative programs to control health care costs are starting up. The Affordable Care Act is working and Connecticut’s exchange will be a part of that, but there is still a lot of work to be done.
Ellen Andrews is the executive director of the Connecticut Health Policy Project.